Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

← Back to the worklist · Whole encounter ENC-00067

Jun Galloway: Obesity

ENC-00067 · 73M · Hospital Medicine · admitted Sun Nov 08, 2026 06:57 PM · in hospital · attending Dr. Cyrus Ellingham

Specificity gap Criteria met Open In hospital: concurrent review Model draft failed the query linter: edit before sending

Documented “obesity” (E66.9); criteria support the more specific Obesity, class 3 (E66.813).

Documented vs supported

Documented: “obesity” · E66.9 Obesity, unspecified
Criteria support: Obesity, class 3 · E66.813 Obesity, class 3
Outcome: BMI 43.6 (class 3)
Rule: Obesity class from BMI v2026.11-1
Published source: CDC: Adult BMI Categories (2024), Class 1: 30 to <35; class 2: 35 to <40; class 3: 40 or higher (adults aged 20 and over) · source (checked 2026-11-14)

Effect if the clinician agrees (illustrative)

Change: E66.9 -> E66.813
Secondary-diagnosis level: non-CC → non-CC
MS-DRG (illustrative): 193 Simple pneumonia and pleurisy with MCC → 193 Simple pneumonia and pleurisy with MCC
Relative weight: 1.3144 → 1.3144 (+0.0000)
Codes before: J18.9, E66.9, N18.32, I50.9, L89.154
Codes after: J18.9, N18.32, I50.9, L89.154, E66.813, Z68.41

All open gaps on this encounter together: MS-DRG 193 → 193 (RW +0.0000). The grouping does not change; the record becomes accurate.

CC/MCC status, CC exclusions (subset) and relative weights from the public CMS FY2026 IPPS final rule tables (5, 6I, 6J, 6K). This is not a grouper and not a payment estimate. Queries never mention any of this.

Severity documentation index change SIMULATED

0.5 points

SIMULATED: Illustrative severity weights (MCC = 1.0, CC = 0.5, non-CC = 0) summed over secondary diagnoses; not a validated risk-adjustment model and not a measured effect.

Evidence

Structured values are read by code from the cited rows. Note facts are shown only when the model's quote was found verbatim in the note.

Evidence (each item cited to a source row or a quoted span)
Input	Value	Source
BMI from charted height and weight (kg/m2)	43.6	height 172 cm, weight 128.9 kg -> BMI 43.6 · encounter ENC-00067
Age (years)	73	age 73 · encounter ENC-00067

Rule trace (inputs, thresholds, outcome)

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=73, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=43.6, t.c3=40	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2100); clinical indicators and answer options assembled by code from the rule and the record. The model's draft failed the linter (leading, leading, question_form): edit it before sending.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: weight-related documentation
Encounter: ENC-00067   Patient: Jun Galloway   To: Dr. Cyrus Ellingham

Clinical indicators from the health record:
- Documented in the record: "obesity" [Progress note DOC-000232]
- height 172 cm, weight 128.9 kg -> BMI 43.6 [encounter ENC-00067]

Question:
The BMI above meets criteria for obesity; please document the obesity class.

Response options (select one or write your own):
( ) Obesity, class 3 (BMI 40 or higher)
( ) Obesity, class 2 (BMI 35-39.9)
( ) Other (please specify): ____________
( ) Unable to determine

Please respond based on your independent clinical judgement. Any response, including "unable to determine", is acceptable. This query and your response are kept as part of the health record.

Other findings on this encounter

Heart failure · Specificity gap Documented “heart failure” (I50.9); criteria support the more specific Acute on chronic diastolic (HFpEF) heart failure (I50.33).
Hyponatraemia · Specificity gap Criteria support Hyponatraemia (profound) (E87.1); no corresponding diagnosis is documented.
Pressure injury · Clinical validation gap Documented “stage 4 sacral pressure ulcer” (L89.154) conflicts with what the criteria support (Pressure injury of sacral region, stage 2, L89.152).

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2100	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00067, ENC-00067.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 3b74416f029a
1274	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00067, ENC-00067.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry c6f519ea97a3
532	2026-11-14T18:29:04	system:llm system	`llm.call`	ENC-00067, ENC-00067.obesity	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 17ada6b44eb1 output 0030666b166c entry 735cad39f21f